If an ankle is fractured or arthritis interferes with function and causes pain that can't be controlled with medication, surgery may be an option – or a necessity. Here are some of the most commonly performed ankle surgeries.

Fracture repair. The most common reason for ankle surgery is to repair bones that have been fractured. The exact procedure used will depend on which bone is broken and how severely. Surgery may require the placement of hardware, such as metal plates and screws, to hold the bone pieces in place while they heal.

Read about the most common types of ankle fractures and the surgeries to repair them from the American Academy of Orthopaedic Surgery

Ankle arthroscopy. Ankle arthroscopy is a minimally invasive surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin over the ankles. Surgeons may use the procedure to remove pieces of cartilage or bone debris from the joint space or to evaluate or repair a damaged ligament.

Read more about ankle arthroscopy from the Arthroscopy Association of North America. 

Ankle fusion. This procedure involves surgically removing the surfaces of the joints affected by arthritis and joining the bones with plates and screws until they grow together, or fuse. While the procedure leaves the ankle without up-and-down or side-to-side movement, it can be an effective and permanent pain relief option for ankles affected by arthritis. If one ankle is fused, it is important that the opposite ankle still has good mobility.

Ankle replacement. Although the procedure is far less common than hip or knee replacement, replacing a damaged ankle may be an option when arthritis interferes with joint function and causes pain that is not relieved by medication.  During ankle replacement, the surgeon makes an incision in the front of the ankle, removes the damaged bone and joint cartilage, reshapes the involved bones and then attaches the parts of the artificial joint, often with a special glue. The surgeon creates a bone graft between the ends of the tibula and places screws through the two bones to support and stabilize the ankle.

Ankle distraction arthroplasty. This innovative procedure uses an external fixator, or frame, much like scaffolding, which is assembled around the lower leg and foot and surgically attached with pins and wires. The frame pulls the damaged joint surfaces apart and, in recent MRI studies, has been shown to reverse the effects of arthritis by allowing the dense bone underneath the cartilage to soften, and in return, allowing cartilage lost from arthritis to regenerate through the body’s natural healing process. Unlike ankle replacement or ankle fusion, ankle distraction arthroplasty preserves the joint and its natural motion. Performed successfully in Europe for years, this procedure is relatively new to the U.S. and not widely performed in this country.

Cartilage stimulating procedures, such as neo-cartilage tissue formation, are often performed in conjunction with distraction to help speed the process. Stem cells are harvested from the patient’s pelvis with a needle and injected into the ankle joint.

Learn more about ankle distraction arthroplasty from the Hospital for Special Surgery.